Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr, Mainz, Germany.
Department of Ophthalmology, Foshan Second People's Hospital, 78 Weiguo Road, Chancheng District, Foshan, Guangdong Province, China.
Medicine (Baltimore). 2022 Mar 11;101(10):e29005. doi: 10.1097/MD.0000000000029005.
Ocular involvements in systemic lupus erythematosus (SLE) are not rare but extremely varied. Here we present a very meaningful case with unilateral branch retinal artery occlusion (BRAO) secondary to undetected SLE, for which immunotherapy showed significant effect, which led to complete resolution of macular edema.
A 31-year-old female patient, so far without any previous illnesses, presented with a sudden onset of painless diminution of vision in left eye for 5 days. Diagnosis: Signs of branch retinal artery occlusion and macular ischemic edema were observed on the left fundus, which was further confirmed by Fundus fluorescein angiography and OCT. BRAO was initially proposed. However, after ophthalmological treatment for BRAO, visual acuity and macular edema improvement was limited. Physical examination revealed erythema on the hands and feet, together with her experience of hair loss and joint pain. The patient was diagnosed with SLE.
The patient received systemic immunotherapy, which resulted in visual improvement to 20/20.
This is a rare monocular vaso-occlusive retinopathy in SLE with mainly diffuse nonperfusion and small arterial and arteriolar occlusion in the retina, as distinct from more common vasculitis. Even without intravitreal injection of anti-VEGF, systemic immunotherapy can be effective for the treatment of macular edema.
系统性红斑狼疮（SLE）的眼部受累并不罕见，但表现极其多样。本文报道了 1 例单侧视网膜分支动脉阻塞（BRAO）继发于未被发现的 SLE 的极有意义的病例，免疫治疗对此有显著疗效，导致黄斑水肿完全消退。
1 名 31 岁女性，平素体健，突发左眼无痛性视力下降 5 天。诊断：左眼眼底可见分支动脉阻塞及黄斑缺血性水肿的表现，眼底荧光血管造影及 OCT 进一步证实。起初拟诊为 BRAO。但 BRAO 眼内治疗后，视力及黄斑水肿改善有限。体格检查发现手足红斑，且有脱发及关节痛病史。最终诊断为 SLE。
患者接受全身免疫治疗后，视力提高至 20/20。
这是 SLE 罕见的单眼血管阻塞性视网膜病变，主要表现为弥漫性无灌注和视网膜小动脉及小动脉阻塞，与更常见的血管炎不同。即使未行眼内抗 VEGF 注射，全身免疫治疗对黄斑水肿的治疗也可能有效。
